We all have unique relationships with our bowel movements. You get to know it so intimately that you know exactly what and where will make you go. Like, there’s the one store that makes you beeline for the bathroom as soon as you walk in, or there’s the give and take that exists between you and coffee first thing in the morning. But nothing says “complicated relationship” more than thinking you may have IBS or irritable bowel syndrome.
According to the American College of Gastroenterology, about 5% of the population (or 1 in 20 people) in the US struggle with IBS, and studies have revealed that IBS is more common in women than men.
While the common triggers for IBS can span from stress to diet to environmental factors, for women, fluctuations in their menstrual cycle also play a big role.
“Studies suggest that there is more diarrhea during the menstrual phase and more constipation during the luteal phase,” explains Dr. Asma Khapra, Assistant Clinical Professor at UVA School of Medicine and Partner Gastroenterologist at Mahana Therapeutics.
Specifically, increased progesterone during the luteal phase can slow gut motility, which causes more constipation, while increased estrogen levels during the follicular phase do the opposite and make diarrhea more common for those who struggle with IBS.
Whether you know you have IBS or are curious if your hormones or diets are the culprits behind your rollercoaster bathroom visits, here’s what to know for your next doctor visit.
What are the most common IBS symptoms?
We mentioned diarrhea and constipation, but there are actually three other symptoms that are common for those who struggle with IBS. According to Dr. Khapra, those include abdominal pain, bloating, and an urgency to go to the bathroom.
The American College of Gastroenterology also notes that abdominal pain (not bowel movements) is the number one IBS symptom for most people.
There are three main types of IBS: IBS-C (IBS with constipation), IBS-D (IBS with diarrhea), and IBS-Mixed (IBS with a mix of constipation and diarrhea).
One way to start assessing whether you are on the IBS spectrum is to notice your own symptoms and when they pop up.
“First I evaluate [your] diet to see if there are any triggers,” suggests Dr. Khapra. “Avoid some of the obvious dietary triggers – dairy, processed foods, sugars, caffeine (especially for diarrhea). Decrease stress and increase exercise, yoga, and mindfulness. See if there are any obvious hormonal triggers and associations with the menstrual cycle. Improve sleep.”
Taking time to self-assess will help equip you with more information for the next big step in finding out if you have IBS — turning to a doctor.
What should I do if I think I have IBS?
First and foremost, Dr. Khapra suggests keeping this in mind:
“The current guidelines suggest that a combined and holistic approach to treatment is the best way to address IBS - this includes diet modifications, medications, exercise/stress reduction techniques, along with cognitive behavioral therapy (CBT) and/or gut hypnosis and generally avoiding triggers.”
So there is help and support available to you; it’s just a matter of figuring out what you’re contending with.
Once you turn to your care team, doctors will typically use the clinical criteria by the Rome IV Foundation to determine if you have IBS and what the best course of action is for you.
According to Dr. Khapra, the criteria include determining changes in things like the frequency and consistency/form of your stool. You can also ask your doctor for additional tests for celiac, SIBO, and thyroid disease, which can help eliminate other potential causes of your symptoms.
“In the last 10 years, there have been great advances in IBS, multiple medications, diets, and holistic treatments that can be effective,” explains Dr. Khapra. “Prescription medications are available for both flares and long-term control of IBS.” Alternatively, there are digital programs delivering therapy via apps, such as FDA-cleared Mahana IBS for gut-directed cognitive behavioral therapy (CBT) prescribed by Health Care Professionals.
No matter when or how your gut symptoms flare up, it’s important to remember that it’s not all in your head and that there is a path forward for you. Jot down your symptoms and take all of your information to your doctor so you can learn what the next step is, or visit Mahana's Provider Finder to easily find a healthcare practitioner with expertise in IBS who can support you.
Vivian Nunez is a writer, content creator, and host of Happy To Be Here podcast. Her award-winning Instagram community has created pathways for speaking on traditionally taboo topics, like mental health and grief. You can find Vivian @vivnunez on Instagram/TikTok and her writing on both Medium and her blog, vivnunez.com.